Dialectical behaviour therapy: Selena Gomez is an advocate, but what is it?

Pop singer Selena Gomez recently entered a treatment facility to address her ongoing issues related to anxiety and depression, and is reportedly receiving dialectical behaviour therapy (DBT), a complex type of therapy that was first developed to treat borderline personality disorder but is now used to treat a host of mental health conditions.

The 26-year-old was hospitalized twice in late September and early October, and has suffered from “an emotional breakdown.” Gomez is now reportedly at an east coast psychiatric facility and is receiving DBT — something she has talked about in the past.

“DBT has completely changed my life,” she told Vogue in March 2017. “I wish more people would talk about therapy.”

But what exactly is DBT, and how does it differ from other forms of therapy? According to Dr. Shelley McMain, an associate professor in the Department of Psychiatry at the University of Toronto and the head of the Borderline Personality Disorder Clinic at Toronto’s Centre for Addiction and Mental Health (CAMH), DBT is “a broad-based cognitive behaviour therapy” that has a “strong focus on acceptance.”

What is DBT?

DBT was originally developed by American psychologist Dr. Marsha Linehan in the 80s to treat patients with borderline personality disorder and chronic suicidal ideation. McMain said the first treatment study of DBT was published in 1991, which showed it was an effective treatment for people with borderline personality disorder — something people thought was previously untreatable.

DBT treatment, according to McMain, integrates two seemingly opposite strategies: acceptance of experiences and behaviours, and the skills to make change and better manage emotion.

“In practice, DBT therapists tend to move very rapidly between very opposite ways of engaging,” McMain told Global News. “On the one hand conveying a very strong message of acceptance, and coupling that with a very strong emphasis or message to the individual that they need to make changes.”

How does DBT work?

DBT is based on cognitive behaviour therapy (CBT), a popular form of psychotherapy used to treat many mental health issues, including anxiety and depression, CAMH says. With CBT, people are taught to challenge and change their thoughts and behaviours. But with DBT, people are instead taught to accept their thoughts and feelings, while also learning techniques to deal with them.

DBT programs often require a one-year commitment, according to CAMH. There are shorter programs, however, which can help people manage their emotions.

When someone is undergoing DBT, they typically have both one-on-one counselling and group therapy. This is also what differs it from many other types of therapy, which are typically done in a patient/therapist-only environment.

“As it was originally designed, standard DBT is a comprehensive multimodal treatment, and there are four core modules,” McMain said.

“There’s individual therapy, there’s skills training — which is done in the often in groups — there’s also after-hour coaching so clients have the ability to contact therapists outside of regular hours, and there’s also a consultation meeting for clinicians which is held once a week, and that’s designed to treat the therapist.”

What is DBT used for?

DBT is now more widely used to treat other mental health issues including self-harm, depression, PTSD, eating disorders and substance abuse issues.

“Often, DBT is really geared towards people who have multiple, often complex, disorders,” McMain said. “Many individuals being treated with DBT may have comorbid personality disorder and post-traumatic stress disorder, and meet criteria for a mood disorder or anxiety disorder.”